Anthem, Inc. Utilization Management Rep I, II, III in Norfolk, Virginia
SHIFT: Day Job
Responsible for coordinating cases for precertification and prior authorization review. Primary duties may include, but are not limited to:
• Managing incoming calls or incoming post services claims work. • Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requests. • Refers cases requiring clinical review to a Nurse reviewer. • Responsible for the identification and data entry of referral requests into the UM system in accordance with the plan certificate. • Responds to telephone and written inquiries from clients, providers and in-house departments. • Conducts clinical screening process. • Authorizes initial set of sessions to provider. • Checks benefits for facility-based treatment. • Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner.
• Requires High school diploma/GED.
• 1 year of customer service or call-center experience.
• Proficient analytical, written and oral communication skills; or any combination of education and experience, which would provide an equivalent background.
• Medical terminology training and experience in medical or insurance field preferred.
• For URAC accredited areas the following applies: Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at careers.antheminc.com. An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.